J Korean Med Sci.  2011 Jul;26(7):959-961. 10.3346/jkms.2011.26.7.959.

Long QT Syndrome and Torsade de Pointes Associated with Takotsubo Cardiomyopathy

• Ahn JH
• Park SH
• Shin WY
• Lee SW
• Lee SJ
• Jin DK
• Lee HM
• Eun JY

• KMID: 1094271
• DOI: http://doi.org/10.3346/jkms.2011.26.7.959

Abstract

Prolongation of QTc interval associated with Takotsubo cardiomyopathy (TC) has previously been reported in published case series. We report an unusual case of a patient who presented with TC associated with long-QT syndrome and developed cardiac arrest secondary to torsade de pointes. Since QT prolongation and bradycardia persisted after the resolution of TC, the patient received permanent pacemaker. Since then additional event did not occur. QT prolongation and bradycardia could be persistent even after recovery of TC, and permanent pacemaker insertion may be a treatment option of long QT syndrome related with TC.

Keyword

Takotsubo Cardiomyopathy; Torsade de pointes; QT prolongation

MeSH Terms

Aged
Bradycardia/diagnosis/therapy
Cardiac Pacing, Artificial
Coronary Angiography
Diagnosis, Differential
Electrocardiography
Female
Heart Arrest/diagnosis/etiology
Humans
Long QT Syndrome/*diagnosis/etiology
Takotsubo Cardiomyopathy/complications/*diagnosis/ultrasonography
Torsades de Pointes/*diagnosis/etiology

Figure

• 

  Fig. 1 Time course of ECG changes. (A) Admission electrocardiogram (ECG) shows T-wave inversion in precordial leads and a QTc interval of 580 ms. (B) ECG on the second day shows torsade de pointes initiated by a junctional rhythm with QT prolongation and R on T phenomenon. (C) ECG on the 4th day shows a junctional rhythm with QT prolongation (QTc = 653 ms) and R-on-T phenomenon (D) ECG on the 20th day shows a severe bradycardia with QT prolongation. (E, F) ECG and 3 months after pacemaker insertion still shows QT prolongation and T-wave inversion in precordial leads.

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  Fig. 2 Two-dimensional echocardiogrphic findings on admission and 2 weeks later. On admission the left ventricular mid wall and apex showed ballooning akinesis. (A) End-diastole. (B) End-systole. Two weeks later, these findings disappeared, and left ventricular contraction nearly normalized. (C) End-diastole, (D) End-systole.

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  Fig. 3 (A, B) Coronary angiogram shows only a small atheroma.

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